STUDY FOUR: MANAGING DEPRESSION

‘If there is a hell on earth it is to be found in a melancholy man’s heart.’ Robert Burton: An Anatomy of Melancholy

Note: This study aims to give you a practical [as distinct from scientific] understanding of depression – what it looks like, how it affects you, and what you can do about it. There is a point at which depression becomes what is called ‘clinical’ depression. At this point you need to seek professional advice and help.

There are excellent Internet resources on depression. Here are two helpful Australian websites:

You are tired most of the time.Your never have enough energy.Your sexual drive and interest decrease.Your sleep is disturbed.You gain or lose weight without meaning to.

Depression affects your mind and emotions:

You feel ‘down’ most or all of the time.You can’t get motivated to do anything – everything is just too hard or too complex.You feel worthless or guilty a lot of the time.You lose interest in household tasks, work, family, friends, etc.You feel anxious, agitated or restless.You focus on dark thoughts – of death or calamity.You lose your sense of meaning and purpose.You feel like giving in and giving up.At the extreme, you think about suicide.

Note: A number of the above ‘symptoms’ may be caused by an underlying physical/medical condition. If you are suffering a number of these ‘symptoms’ do not jump to the conclusion that you are depressed. Your ‘depression’ may indeed be depression, but it may itself be a symptom of a physical condition. See your medical doctor for a physical check-up.

A.3 Recognize that depression has many underlying causes including:

Some underlying causes of depression are obvious, others are more difficult to track down. The common underlying causes are:

For the Christian, depression due to social and/or spiritual causes is often due directly to our wrong personal responses to some causes, particularly circumstantial, social and spiritual causes, rather than to the causes themselves. These wrong personal responses that can plummet us into depression include:

We need to note some groups of people who are more likely to ‘feel depressed’ than others:

[1] people with low self-esteem; [2] perfectionists;[3] people who are over sensitive to criticism;[4] people who are not accountable to anyone and have to plan and implement their daily work with no one to report to.

Statistical data indicates that higher rates of depression are related to a range of factors, all of which can cause stress and/or anxiety [but not every one with these experiences suffers depression]:

PovertyPoor educationBelonging to a minority or feeling differentSocial isolation and lonelinessSeparation and divorceChronic illnessDeath of a loved oneNormal life changes: puberty; childbirth; menopause and middle life; empty nest.Life Stressors: job loss or uncertainty; illness in self or loved one; relationship difficulties.People who have to manage their own time, such as housewives, pastors of small churches.Even the weather: research has shown that depressive disorder related to winter. Called SAD (Seasonal Affect Disorder)

Complete Section #1 in the Study Four Worksheet now.

B. HOW TO DEAL WITH DEPRESSION

B.1 Avoiding depressionObviously, you would prefer to avoid depression, and there are several things you can do to keep some kinds of depression from taking over your life.

Nutrition: Eat a well balanced diet. Depression is a ‘mental illness’. Your brain needs a regular supply of a range of nutrients to function properly. ‘Junk foods’ work against sound mental health, adversely affecting your thoughts, attitudes and emotions. If you have food allergies, avoid them, as they can also affect your mood and hold you in a state of mild depression.

Fitness: Factor regular physical activity into your week. [This is part of your goal setting and time management.] Physical activity includes various tasks around the house and garden. It may mean walking or cycling to work instead of driving or using public transport. It may be aerobic or gym exercises, or playing a sport. Physical exercise improves your circulation. Good circulation is a key factor in mental health.

Relationships: Even those of us who have low social needs need connection with other people. It is important to intentionally maintain our key relationships – with family, friends and our church community. Isolation and lack of accountability are breeding grounds for depression.

Circumstances: It is important to keep in mind that some life circumstances can cause ‘normal’ depression, and to be prepared to deal with this ‘normal’ depression appropriately so that it does not take over our lives and become ‘clinical’ depression.

Self-management: Defining your priorities and principles and your mission statement, and setting your long and short term goals, give purpose, meaning and direction to your life. When you experience blue days or ‘normal’ depression these definitions help you to continue to function normally even though you do not feel like it.

Biblical perspectives: Make sure that your perspectives about yourself, others, God and circumstances are biblical. Good nutrition, regular exercise and relationships, even self-management, are not much help in avoiding depression if you persist in holding onto non-biblical perceptions. [See Section C below.]

Keep your living environment bright and cheerful. Maintain a clean, uncluttered environment. Resist long periods of time on the telephone.Avoid spending too much time watching television. Listen to uplifting and cheerful music. Write thank you and encouragement notes to others. Set small attainable goals each day.

“My son, preserve sound judgment and discernment, do not let them out of your sight; they will be life for you, an ornament to grace your neck.” [Proverbs 3:21-24]

B.3 Coping with depression

We need to recognize, and avoid, various inappropriate ways of coping with depression:

I deny that I am depressed.I refuse to pursue or accept appropriate help.I camouflage my depression by bizarre behavior.I camouflage my depression by over-elation.I blame everyone and everyone except myself.I blame myself, and am overcome with guilt.I blame myself, and think I’m worthless.I come to believe there is no way out for me.I lose confidence in God and his love for me.I get myself further in and further down in the spiral of depression, with each sinful response I make.

It seems quite clear that we do not like to admit that we are depressed, so we will do almost anything to convince ourselves and others that we are not. It also seems clear that, if we do admit to being depressed, we do not like to own any personal responsibility for our depression or for getting out of it. In our denial of the depression or the responsibility we get ourselves further and further in. An undesirable long-term is outcome is to define oneself by one’s depression.

Avoiding these inappropriate reactions to depression, what can we do to cope with depression?

Because depression has a range of faces and a range of causes, there is also a range of ways to deal with depression:

Some depression can be fixed by having a good talk to a friend. [And even if this by itself does not fix your depression, it is essential that you talk honestly and pray about your depression with a friend or mentor.]

Some depression can be fixed by regular physical activity or work-outs.

Some depression can be fixed by improving your nutrition and/or nutritional supplements. [Seek the advice of a nutritionist.]

Some depression can be fixed by biblical repentance and a biblical approach to guilt.

Some depression can be fixed by bringing your perceptions about yourself in line with Biblical teaching about what Jesus Christ has done for you and who you are ‘in Christ’.

Some depression can be fixed by counselling from a Christian pastor or counsellor.

Some depression can be fixed by medical drugs or professional therapy. [If you are averse to taking depression medication, seek help from a naturopath first. If your depression is beyond his/her scope he/she will advise to seek medical help.]

Because your over-riding purpose as a Christian is ‘to glorify God and enjoy him forever’ [Westminster Catechism] you will be committed to work through your depression by whichever of the above means is appropriate. And in all of the above you will make prayer a priority.

B.4 To do list for a person with mild depression[Adapted from material provided by Jan Monument, Clinical Psychologist].

B.4.1 Balance ActivitiesMake a list of all the things you do because you have to (Type A activities) and all those things that you enjoy doing (Type B activities). In order to keep in a good mood, we really need only a few Type B activities to help us cope with the many Type A activities.

Often we have simply allowed ourselves to get swamped with all Type A activities, either because we don’t like saying “No” to people, or because we’re carrying a lot of mental “shoulds” around [see lesson on expectations and perceptions]. It is very important to strike some sort of balance between the two, especially when you genuinely have many Type A activities that truly need to be attended to.

B.4.2 Reduce Your AnxietyIf you’re an anxious person, then your anxiety is going to interfere with your ability enjoy yourself, either in specific situations, or more generally. Consequently most anxious people end up generally depressed. While you’re working on your anxiety problems, notice how hard it is to feel depressed when you’re feeling confident because you have got control of your anxiety. And notice how, when your anxiety messes something up for you, you tend to end up feeling depressed afterwards.

B.4.3 Handle Changes CarefullyAny changes have the potential to reduce pleasant experiences in a person’s life – death in the family, relocation, transfer, retirement, and even a promotion. Many of the activities that we used to do and enjoy are often no longer possible after a change and will need to be dealt with in some way or other, such as being replaced or accepted as lost.

B.4.4 Positive ThinkingIdentifying negative thoughts (eg. about how incompetent we are and how hopeless things are) and disputing these is essential. Don’t lose perspective; remember that things will not always be how they are today.

B.4.5 Find a Purpose for Living (If dealing with a non-Christian introduce them to Christ)What gives you a sense of joy?What values do you hold that are really important?The more you weave enjoyable and meaningful activities into your life, the more you will reduce depression.

B.4.6 Action leads to motivation: fight the lethargy!Most depression can be actively combated, and the best way of doing this is to focus away from the feeling part and view it as an intellectual problem to be solved. Viewed in this way, the third A, below …

1. Awareness (aware of the problem), 2. Answering (challenge the negative mind set), 3. Action …. becomes important, because there are lots of things you can do.

Make an effort to keep up social contacts. Try to cultivate a range of friends, both old and young. Don’t restrict your socialising to a narrow group of people.

Find your spirit-lifters (e.g.: things that reliably give you pleasure, such as TV, books, games etc). Are you giving yourself enough time with these?

Try to behave as though you aren’t depressed, because we often induce changes in mood simply by acting differently (that is, we don’t have to wait for our mood to change first).

Complete Section #2 in the Study Four Worksheet now.

D. DEPRESSION AND FAITH

Depression and faith can exist together. Depression does not mean that you are a ‘bad Christian’ or that you have ‘lost your faith’. This is evident in the Psalms, where we read:

‘Why are you downcast, Oh my soul?Why so disturbed within me?Put your hope in God, for I will yet praise him, my Saviour and my God.’ [Psalm 43:5]

‘Out of the depths I cry to you, O LORD.O Lord, hear my voice.Let your ears be attentive to my cry for mercy.If you, O LORD, kept a record of sins,O Lord, who could stand?But with you there is forgiveness; therefore you are feared.’ [Psalm 130:1-4]

There is obvious deep, biblical faith in both of these references. There is also obvious ‘depression’.

Notice that the Psalm writers cope with their depression by:

Acknowledging his depression [‘downcast’, ‘disturbed’, ‘depths’]Calling out to the Lord [‘I cry to you’, ‘my cry’].Recalling his knowledge of God [as one who forgives and is merciful].Acknowledging that he is a sinner who sins.Trusting in God’s mercy and forgiveness.Expressing biblical hope.

From this we can identify six foundational biblical truths that faith must recognize, and that faith will hold to during any times of depression:

D.1 We live in a fallen worldThe perfection of God’s world ceased in Genesis 3. It will be restored in Revelation 21. In between we live in a world coloured by sin, multi-dimensional suffering, and death. We live in a world where temptations assail us. We live in a world where Satan’s deceptions have distorted our human worldviews and values.

In a phrase: things are wrong.

This is the context in which depression invades our minds. Is was not there in Genesis 1 and 2. It will not be there in Revelation 21 and 22. In this context of sin, suffering and death, in this context of temptations and deceptions, depression is not at all surprising.

We were not created for alienation from God.We were not created for alienation from each other.We were not created for alienation within ourselves.We were not created for alienation from our environment.We were not created for suffering and death.

In this in-between world, where life is out of sync with its God-given purpose, depression happens. Our first response should be to honestly recognize it and acknowledge it.

D.2 We cannot cope by ourselvesIn the perfect world we were created for dependence on God. It was our attempt at independence from God and his word that resulted in the mess we are in. If, as perfect humans, we were created for dependence on God, how much more we need to depend on him in our sin and weakness and in the context of a fallen world!

Prayer is an expression of our createdness and our dependence. When we find ourselves depressed our response should be that of David: to cry out to the Lord. Seek his help. We were never meant to do life without him.

D.3 God has made himself knownGod in his grace has made himself known to us – in creation, in the written Word, and in his Son, Jesus Christ. From these three witnesses we know that God is sovereign, that God is powerful, that God is love, that God is light, that God is a God of grace, mercy and forgiveness. Above all, we know that God is for us. Each of these truths about God speaks directly to us in our depression.

Because he is sovereign no circumstance is beyond his control.Because he is powerful he can bring good even from the bad things.Because he is love we are assured of his care and compassion towards us.Because he is light he is able to disperse our darkness.Because he is gracious, merciful and forgiving our sin has no power or authority to every separate us from him.

D.4 God knows we are sinners who sinOur human efforts to hide or deny our sin are pointless. God knows we are sinners who sin. God knows we are guilty. God knows that our sin legally bans us from his presence. Because God knows this he has done something about it: he sent the Lord Jesus Christ to die as an atoning sacrifice for our sins: Jesus Christ bore our sin in his body on the cross. He took our guilt. He took to condemnation and judgement due to us.

But the death of Christ can do nothing for us while we deny our sin. The death of Christ is powerless to relieve us of our guilt so long as we are determined to somehow atone or make up for that guilt. God knows we can never do this – that we can never and will never be ‘good enough’. It is only when we agree with God about our sin [that is what the Greek word translated ‘confess’ means] that we can receive his forgiveness and be set free from the burden of guilt.

D.5 God relates to us on the basis of graceIn Psalm 130 the writer has absolute assurance that his relationship with God depends totally on God’s mercy and God’s forgiveness. He acknowledges that God’s mercy is the basis of his prayer. He expresses his biblical understanding that no one can stand before God - ‘if you … kept a record of sins … who could stand?’ He expresses total confidence in God’s grace ‘with you there is forgiveness’. This forgiveness means that never again can sin separate us from God. This forgiveness means that we are legally acquitted by God … that never again will any accusation, condemnation or judgement from God ever fall upon us. Jesus Christ bore it all. For us. The ‘law of sin and death’ no longer applies to the Christian believer. God’s grace reigns.

This complete and final removal of guilt, and of a performance-based relationship with God, is one of the key factors in dealing with normal depression.

D.6 Biblical hope In the Bible ‘hope’ is quite different from the wishful thinking embedded in current use of the word. Biblical hope is a grand certainty, a strong assurance, a confidence grounded in the very being of God.

Both of the Psalm writers recognize this:

The first encourages himself: ‘Put your hope in God ‘ [43:5]The second expresses his own confidence – ‘in his word I put my hope’ – and encourages the nation: ‘… put your hope in the LORD’ [130:5,7].

This ‘hope’ in God, this utter confidence, knows several facts about God:

God, and God alone, is Saviour – there is no other Saviour [43:5].God is ‘the LORD’ – the eternally existing, all-sufficient One: the I AM [130].God’s dependability is as certain as morning following night [130:6].God’s love is unfailing [130:7].The redemption provided by God is complete [130:7,8].

If we move to another Psalm in which the writer, King David, is surrounded by multiple layers of stress, we find that his hope expresses his confident knowledge of God. He knows the power and the authority of God, and in these he places his sure and certain hope in the midst of his life situations: my strength, my Rock, my fortress, my deliverer, my rock in whom I take refuge, my shield, the horn of my salvation, my stronghold [Psalm 18:1-2].

In this same Psalm David expresses an additional key factor of biblical hope: that God, and God alone, is God – there is no other God.

‘For who is God besides the LORD?And who is the Rock except our God?’ [18:31].

It is this fact that God is the only God that undergirds all other foci of biblical hope. God alone is God. Not anything man creates and calls ‘god’. Not the devil. Not demons. Not my circumstances. Not myself. Because God alone is God he is also sovereign. He is the one in control, not anything or anyone else. He can take even those things that are opposed to him and contrary to his purpose, and use them for his glory and for the good of those who are his [Romans 8:28].

D.7 Biblical praiseWith this biblical hope to reassure us, even in the pit of our depression, there is room for praise.

Thus David in Psalm 43:5 wrote ‘for I will yet praise him’; and in Psalm 130 the writer praised God for his mercy, forgiveness, unfailing love and redemption, even while crying out to God from the pits. So sure was he of God that he exhorted others to similar trust and similar hope.

“Before I was afflicted I went astray, but now I obey your word.” [Psalm 119:67

Used by God to slow you down and cause you to reflect inwardly

“Therefore we do not loose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day.” [2 Corinthians 4:16]

Used by God to reveal your weakness

“[The Lord said] ‘My grace is sufficient for you, for my power is made perfect in weakness.’ Therefore I will boast all the more gladly about my weaknesses, so that Christ’s power may rest on me.” [2 Corinthians 12:9]

Used by God to bring you to Himself

“Let us draw near to God with a sincere heart in full assurance of faith, having our hearts sprinkled to cleanse us from a guilty conscience and having our bodies washed with pure water.” [Hebrews 10:22]

Used by God to develop your trust in Him

“Why are you downcast, O my soul? Why so disturbed within me? Put your hope in God, for I will yet praise him, my saviour and my God.” [Psalm 43:5]

Used by God to be a healing process for damaged emotions

“Heal me, O Lord, and I will be healed; save me and I will be saved, for You are the One I praise.” [Jeremiah 17:14]

Used by God to develop perseverance and maturity

“Consider it pure joy, my brothers, whenever you face trials of many kinds, because you know that the testing of your faith develops perseverance. Perseverance must finish its work so that you may be more mature and complete, not lacking anything.” [James 1:2-4]

Used by God to develop worth and value in your life

“Are not 5 sparrows sold for 2 pennies? Yet not one of them is forgotten by God. Indeed, the very hairs of your head are all numbered. Don’t be afraid; you are worth more than sparrows.” [Luke 12:6-7]

Used by God to cause you to rely on His resources

“His divine power has given us everything we need for life and godliness through our knowledge of Him who called us by His own glory and goodness. Through these He has given us His very great and precious promises, so that through them you may participate in the divine nature and escape the corruption in the world caused by evil desires.” [2 Peter 1:3-4]

Used by God to increase your compassion and understanding for others

“Praise be to the God and father of our Lord Jesus Christ, the father of compassion and the God of all comfort, who comforts us in all our troubles, so that we can comfort those in any trouble with the comfort we ourselves have received from God.” [2 Corinthians 1:3-4]

Complete Section #3 in the Study Four Worksheet now.

CONCLUDING INSTRUCTIONS

For yourself:

Discuss the issue of depression with your Mentor or Pastor.

If necessary plan some personal strategies for coping with depression.

Seek professional help if this is considered appropriate.

For others:Know your limitsBefore trying to help someone suffering from depression ask:

Is this something I am equipped to handle?Does this person need professional help? [Counselling or Medication]Are they at risk of harming themselves and/or others?

To recognize the need to recommend professional help is extremely important.

Equally important for the person with depression is your continued support, love and prayer. Walk beside them. Cry with them when they cry, but also express your faith and your hope.